On the third anniversary of the Affordable Care Act, Sen. Sheldon Whitehouse, a strong supporter on the law, called upon the Obama Administration to set a cost-savings target for the nation’s health care delivery system reform. “A cost-savings target will focus, guide and spur the administration’s efforts in a manner that vague intentions ‘to bend the health care cost curve’ will not.” He urged the administration to set a specific cost-savings target, with a number and a date.

Whitehouse has been an outspoken advocate in Washington for reshaping health care priorities. His bill to spur research on “recalcitrant” cancers was signed into the law in January, and Whitehouse plans to re-introduce similar legislation to encourage breast cancer research to move forward in a more collaborative fashion.

Providence Business News caught up with Whitehouse recently and asked him to talk about the challenges he faces in the Senate championing an improved health care delivery system.

PBN: How should the government respond to businesses that attempt to willfully evade the requirements and mandates of the Affordable Care Act, such as those businesses who attempt to reclassify full-time help as part-time contract workers?

WHITEHOUSE: I think we need to see exactly how much of that really transpires. The information from Massachusetts, I believe, is that, by in large, most employers went along with coverage requirements, and there wasn’t a reclassification of workers to avoid offering health coverage.

I think it’s something to watch – particularly in the restaurant industry, that’s where I have heard the most concern. It’s something we need to watch and see how it develops.

In Rhode Island, people still have access to the health insurance exchange in order to get basic health insurance. From a [consumer’s] eye view, it’s less of an issue. Rhode Islanders will still find that they have improved access to affordable insurance, even if their employer’s choose to take that step.

PBN: Given your advocacy on behalf of addressing climate change and global warming, do you believe there is a way to make the externalities of the health costs of carbon more visible, similar to what has been done with tobacco?

WHITEHOUSE: That’s an interesting question. In terms of carbon solutions, as you know, we have launched a proposed framework for a carbon fee, trying to reflect the social costs of carbon.

One of the largest pieces of the social cost of carbon comes home very clearly to Rhode Island, when a mom has to bring her child to an emergency room because of an asthma attacked on one of those bad ozone days in Rhode Island, caused by the upwind pollution from the Midwestern coal-fired power plants that inject the pollution high in the atmosphere so that it lands on us.

It’s not just a theoretical exercise; it really comes home with those bad air days and the associated health costs.

As the case becomes clear and clearer, connecting the cause to the harm, the avenue for successful litigation opens up more and more. If that day isn’t here yet, that day is coming, we clearly known about the connections.

My main focus is on improving the efficiencies of health care delivery, on the internalities, not the externalities: why we are running a 50 percent more inefficient health care system as compared to other industrialized countries.

PBN: What do you think about Dr. Michael Fine’s proposal to build out a system of primary care centers in Rhode Island, what he is calling the Primary Care Trust?

WHITEHOUSE: I think it’s a terrific idea, for our health director to put the emphasis on primary care and prevention. It’s an area that where we need to pay more attention.

We’ve seen how we’ve been slip-sliding away from primary care into specialties.

Medical students come in wanting to become primary care doctors, but the pay is a lot more to become a specialist.

Trying to build up primary care is important. Investments in primary care and prevention can save money and keep patients healthier. Dr. Fine has put the spotlight in exactly the right area. I applaud that.

PBN: Where do things stand with the breast cancer research legislation, “Accelerating the End of Breast Cancer Act,” that you have championed in Congress?

WHITEHOUSE: We are reintroducing the bill this year. We have gotten a whole bunch of new sponsors lined up. There is some good momentum built up with the passage this past year of the “Recalcitrant Cancer” bill.

We are fully engaged in getting the breast cancer research bill passed. I’m feeling increasingly optimistic.

PBN: Why are Republicans continuing to fight so hard to de-legitimize the Affordable Care Act?

WHITEHOUSE: I don’t think there is a single answer. I do think that it’s been widely documented that shortly after President Obama was elected, the Republican leadership in Washington made a very important political decision – that they would everything they could to deny the president a bipartisan agenda, at all costs.

A lot of the charges have been false propaganda, such as socialized medicine. Look at the VA, with government-paid hospitals and doctors. And veterans love it.

The notion that there is a bureaucrat between you and your doctor is totally fraudulent. Nothing interferes with the doctor treating a patient.

…The test of success [for health care reform] will be what happens to the number of uninsured in Rhode Island. Can we reduce how many people are out in the cold, uninsured, counting on our expensive emergency rooms as where they can get their health care.

As we look at the budget and the deficit and sequestration issues in Washington, the needle of the compass always ends up pointing to health care.

It is an urgent matter that we need to solve – 18 percent of our gross domestic product is spent on health care. If we can reduce that to 12 percent, it would make an enormous difference, if our health care system becomes more humane and efficient.

We simply have got to get it right.

Against the backdrop of that huge problems, here comes Rhode Island. We are doing more to solve it than any other state. I’m very proud about how brave and determined Rhode Island as been as an innovative leader in health care reform. And we’re starting to see the results.

Comments

It is unlikely that "our health care system becomes more humane and efficient" as long as CMS (Medicare) is putting so much pressure on the viability of home health care. CMS should be bolstering the homecare infrastructure (home nursing providers and home medical equipment companies), but instead is challenging their very existence. Once access to this most humane and efficient venue of care is compromised, cost of care will rise exponentially as an unintended consequence of the current aggressive cost containment efforts directed at homecare.

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